OptumRx overcharged Ohio on more than 1.3 million prescription claims, attorney general says

The Columbus Dispatch | Cathy Candisky

The pharmacy benefit manager administering prescription drugs for workers injured on the job overcharged the Ohio Bureau of Workers’ Compensation on more than 1.3 million claims for generic medications, according to a new court filing by Attorney General Dave Yost’s office.

Attorneys for the state asked Franklin County Common Pleas Judge Michael Holbrook to rule OptumRx breached its contract and is liable for unspecified damages.

According to the court filing, OptumRx overcharged the state on 57% of 2.3 million claims between January 2014 and September 2018.

“By failing to follow the pricing rules it agreed to and promised to obey, OptumRx violated its duties to the State of Ohio and BWC and wrongfully pocketed millions of dollars in unearned profits,” the court filing says.

The state sued Texas-based OptumRx last March, leading to several months of mediation that failed to resolve the dispute. Late Friday, attorneys for the state filed a motion for partial summary judgment, arguing “there can be no dispute” that OptumRx violated terms of its contract. Attorneys asked Holbrook to determine damages at a later hearing.

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